Citation style for this article: Dougan S. Steady increase in HIV in the United Kingdom. Euro Surveill. 2003;7(20):pii=2230. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2230
Date of submission:

From 1990 to 1998, new diagnoses of HIV infection in the
United Kingdom (UK) averaged 2675 per year, most among homosexual men. In
1999, however, a rapid increase in numbers of new diagnoses began (figure
1). By the end of March this year there were 5338 reports of new HIV diagnoses
in 2002, representing a 28% increase on numbers of new diagnoses in 2001,
reported by the same time last year. The number is predicted to rise to over
6000 new HIV diagnoses in 2002 as further reports are received. In contrast,
the numbers of new AIDS diagnoses increased annually peaking in 1994 at 1854,
until the widespread use of highly active antiretroviral therapy (HAART) in
the mid nineties led to a fall, numbers stabilising in the late nineties,
with 647 new AIDS diagnoses in 2002 reported so far.

Figure 1: HIV diagnoses and AIDS cases by year of first diagnosis
in the United Kingdom:

(Data to end of March 2003)

Reports of new HIV diagnoses in the UK are received from laboratories and
clinicians, the latter also reporting new AIDS diagnoses. Data presented
are from reports received at the Communicable Disease Surveillance Centre
by the end of March 2003.

Between 1999 and 2002, there were 17 188 new HIV diagnoses; 3058 in 1999,
rising to 5338 in 2002, an increase of over 75%. Of those newly diagnosed
with HIV during this period, where probable route of infection was reported,
9130 (57%) probably acquired infection heterosexually and 5985 (37%) through
sex between men (table 1). Injecting drug use only accounted for 431 infections,
and mother to child exposure for 358. One thousand one hundred and sixty
nine (6.8%) of individuals do not yet have a probable route of infection
assigned; this will decrease as follow up continues.

Table 1: New HIV diagnoses in the United Kingdom between 1999 and
2002, by sex and probable route of exposure
(Data to end of March 2003)

Exposure route

Male

Female

Total(%)

Sex between men*

5985

-

5985(35)

Heterosexual sex**

3472

5657

9130(53)

Injecting drug use

306

125

431(3)

Blood transfusion/products

41

48

89(1)

Mother to child

184

174

358(2)

Other

17

9

26(0.2)

Undetermined**

709

459

1169(7)

Total

10714

6472

17188

*includes 86 individuals who also injected drugs

**total includes 1 individual of unreported sex

Of the 9130 individuals who acquired infection heterosexually, 3472 (38%)
were male and 5657 (62%) female. Where ethnicity was reported, 6095 (73%)
were black African, 1410 (17%) white, and 407 black Caribbean (table 2).
Where reported, 6686 (78%) were probably infected in Africa, 974 (11%) in
the UK, and 374 in Asia (table 3). Heterosexual transmission within the
UK is likely to be underestimated, because if an individual has been exposed
to infection in more than one area of the world, probable country of infection
is allocated to the area with the highest prevalence. In comparison, of
the 5985 homosexual men, 3901 (88%) were white, with most (84%) for whom
a likely country of infection has been recorded, probably infected in the
UK.

Table 2: New HIV diagnoses in the United Kingdom between 1999 and
2002, by probable route of infection and ethnicity
(Data to end of March 2003)

Ethnic group

Men who have sex with men

Heterosexuals

Other/ Undetermined

Total (% of sub total)

White

3901

1410

593

5904(42)

Other/mixed

206

216

89

511(4)

Black Caribbean

165

407

41

613(4)

Black African

82

6095

564

6741(48)

Black other

51

91

11

153(1)

Indian/Pakistani/ Bangladeshi

51

130

29

210(2)

Sub total

4456

8349

1327

14132

Not reported

1529

781

746

3056

Total

5985

9130

2073

17188

Table 3: New HIV diagnoses in the United Kingdom between 1999 and
2002, by probable route of infection and probable region/country of infection
(Data to end of March 2003)

Probable country/region of infection*

Men who have sex with men

Heterosexuals

Other/ Undetermined

Total(% of sub total)

UK

2213

974

206

3393(28)

Africa

52

6686

397

7135(59)

Asia

42

374

42

458(4)

Australasia

32

16

5

53(0.4)

Europe

160

200

133

493(4)

Latin America/ Caribbean

75

299

13

387(3)

North America

60

24

7

91(1)

Sub total

2634

8573

803

12010

Not reported

3351

557

1270

5178

Total

5985

9130

2073

17188

There were 2867 new AIDS diagnoses between 1999 and 2002. As AIDS has become
a poorer marker of infection progression since the introduction of HAART,
reporting of AIDS, particularly when it is not present at HIV diagnosis,
may have decreased, and this may underestimate the true number of new diagnoses
over the period. Where probable route of infection was reported, 1524 (54%)
of those diagnosed with AIDS probably acquired infection heterosexually
and 998 (36%) through sex between men. An individual may have more than
one AIDS defining illness at the time of first AIDS diagnosis. Pneumocystis
carinii pneumonia (PCP) was the most frequently diagnosed AIDS defining
condition among men who have sex with men, with 442 diagnoses. Among heterosexuals,
tuberculosis was diagnosed in 565 individuals, reflecting the high numbers
of black Africans in this exposure group, and PCP was diagnosed in 419 individuals
(table 4).

Table 4: Initial AIDS defining illnesses and number new AIDS diagnoses
by probable route of infection, United Kingdom 1999-2002
(Data to end of March 2003)

Probable route of infection

Initial AIDS defining illness

Men who have sex with men

Heterosexuals

Other

Total(%)

Kaposi's sarcoma

175

81

5

261(8)

Lymphoma

75

51

21

147(4)

Mycobacterium - other

42

57

8

107(3)

Mycobacterium tuberculosis

39

565

32

636(19)

Candidiasis

127

163

42

332(10)

Pneumocystis carinii pneumonia

442

419

112

973(28)

Other opportunistic infection

165

354

121

640(19)

Wasting

86

108

63

257(8)

Encephalopathy

31

26

25

82(2)

Total

1182

1824

429

3435

Total number of individuals*

998

1524

345

2867

*An individual may have more than one initial AIDS defining
illness

The UK's HIV epidemic has changed substantially over the past decade, moving
from one predominantly affecting white homosexual men, to one where HIV
heterosexually acquired in Africa is driving significant rises in numbers
of new HIV diagnoses here. Nevertheless, new diagnoses among white homosexual
men continue. In sharp contrast, AIDS diagnoses have fallen since the introduction
of HAART.

The need to recognise the diversity of the people affected has been acknowledged
by the UK government's National Sexual Health Strategy (1), but effective
action to reduce further spread of HIV within the UK will be hampered if
resources are inadequate to meet the rapidly increasing prevention and care
needs.

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